Summary and Introduction: After surgery, obesity is linked to higher rates of morbidity and mortality. Post-pancreaticoduodenectomy outcomes can be predicted using the measurement of visceral obesity.
Methods: This is an observational prospective study. Using a computed tomography scan, the fat thickness in the retro-renal area was measured to determine visceral obesity. Retro-renal fat thickness (RRFT) of less than 2 cm was used as a marker for visceral obesity. There were two groups of patients: Groups A (RRFT less than 2 cm, non-obese) and B (RRFT greater than 2 cm, obese) Postoperative outcomes were correlated with clinical, demographic, and intraoperative variables.
Results: The study consisted of 56 patients. There were 24 patients in Group B and 32 in Group A, with outcomes that were comparable between the two. Comorbidities such as diabetes mellitus, high blood pressure, and coronary disease were present in 21 of the patients in Group A (65.62 percent) and 17 of the patients in Group B (70.83 percent) (p=0.680). Grades from the American Society of Anesthesiologists (ASA) were comparable (p=0.927). p=0.354, BMI was also comparable. The technique of pancreaticojejunostomy anastomosis, pancreatic texture, and type of pancreaticoduodenectomy were all comparable. Group B had a mean operating time that was 362 36.2 minutes longer than Group A (p=0.001). Group-B had more intraoperative blood loss (p=0.001) (312 36.8 ml vs. 267 23.7 ml). The rates of delayed gastric emptying and postoperative pancreatic fistula were comparable (p=0.402 and p=0.134, respectively). Patients in Group-B had a longer stay in the hospital (p=0.004). Group-B, the obese group, saw one death.
Conclusion: After a pancreaticoduodenectomy, visceral obesity is a risk factor for postoperative complications.
Introduction Obesity is a new lifestyle disorder that affects people all over the world [1]. It is linked to metabolic syndrome development as well as neurological, cardiovascular, and endocrine disorders [2-4]. When undergoing surgery, obese patients are more likely to experience complications [4, 5]. As a result of the systemic compromise that is associated with the procedure, complications can range from surgical site infection (SSI) to mortality [5].
One of the most complex intraabdominal surgeries is the pancreaticoduodenectomy (PD). In high-volume centers, the mortality rate following PD is now less than 3% thanks to recent advancements in perioperative care [6]. However, the morbidity rate, which ranges from 27% to 43% [6-8], is still extremely high. One of the most common and dreaded complications of PD is postoperative pancreatic fistula (POPF). The pancreatico-enteric anastomosis’s integrity directly correlates with PD’s outcome. Numerous risk factors for the onset of POPF following PD have been identified. Risk factors for POPF have been identified as pancreatic texture, main pancreatic duct diameter, and associated comorbidities [6-8]. In numerous large series from high-volume centers, the soft pancreas has consistently been linked to POPF following PD. Patients with visceral obesity, fatty pancreas, and soft pancreas are also more likely to be obese [9-13]. Visceral obesity is characterized by a high deposition of adipose tissue in the abdominal cavity surrounding the viscera, particularly the omentum, mesentery, and retroperitoneum. Visceral obesity is directly linked to the negative effects of metabolic syndrome [9].
Utilizing a variety of dynamic imaging modalities, such as computed tomography (CT) scans [14-17], visceral obesity can be measured prior to surgery. A reliable indicator of visceral obesity is the retro-renal fat thickness (RRFT) measurement on CT scans [16, 17]. Predicting postoperative complications may be made easier with the estimation of visceral obesity by measuring the thickness of the RRFT prior to PD.
In terms of immediate outcomes, including POPF, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and SSI, we report our experience with PD in visceral obese patients. On the CT scan, an RRFT of more than 2 cm was used as a proxy for visceral obesity.
Materials and Procedures The Postgraduate Institute of Medical Education and Research in Chandigarh, India, was the location for this prospective observational study. The study was approved by the institution’s ethics committee (Reference NK/2419/MS/11052-53). All patients with malignant periampullary and pancreatic tumors between the ages of 18 and 80 were included. The study included 56 patients who met the inclusion requirements. Demographic information, a comprehensive clinical history, and physical findings, including BMI, were recorded after obtaining informed written consent. Biochemical, hematological, and coagulation workups were performed on each and every patient. Tumor markers that were relevant were analyzed and recorded. For staging workup, all patients underwent contrast-enhanced computerized tomography (CECT) and ultrasonography (USG). Using a cross-sectional CT scan of the abdomen after a night of fasting, visceral fat in the retro-renal area was measured to determine visceral obesity. After the normal exhalation, it was done in the supine position.
The distance between the junction of the abdominal wall and paraspinal musculature at the level of the left renal vein and the left posterior renal capsule was measured to determine RRFT. Fat tissue was selected from regions with a Hounsfield unit value between 190 and 30. On CT scans, visceral obesity was defined as an RRFT of less than 2 cm. There were two groups of patients: Groups A (RRFT less than 2 cm, non-obese) and B (RRFT greater than 2 cm, obese) The surgical procedure (PD) was carried out in accordance with standard oncological principles, and these patients were staged. The visceral obesity level was correlated with the recorded and analyzed intraoperative variables and postoperative outcomes. The International Study Group of Pancreatic Surgery (ISGPS) guidelines [18] were used to define POPF, DGE, and PPH.
The statistical analysis was carried out with the help of IBM SPSS Statistics for Windows, Version 20.0 (Released in 2011; United States: IBM Corporation, Armonk, New York). Mean standard deviation, median, and interquartile range were used to present quantitative data. Percentages were used to represent categorical variables. The Kolmgorov-Smirnov test was used to measure the quantitative data’s normality. For normally distributed data, the Mann-Whitney test was used, while for skewed variables, the t-test was used. To compare categorical variables, the chi-square test and Fisher’s exact test were utilized. A p-value of less than 0.05 was thought to be significant.
